Appropriateness of quality indicators for older patients with advanced dementia and poor prognosis

David H. Solomon, Neil S. Wenger, Debra Saliba, Roy T. Young, Alan Adelman, Richard K. Besdine, Dan G. Blazer, Christine K. Cassell, Jeffrey L. Cummings, Paul R. Katz, Dalane W. Kitzman, Risa J. Lavizzo-Mourey, Linda C. Mondoux, Rose Popovich, Walter J. Pories, Nanette Wenger

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

OBJECTIVES: To evaluate the applicability of process-of-care quality indicators (QIs) to vulnerable elders and to measure the effect of excluding indicators based on patients' preferences and for advanced dementia and poor prognosis. DESIGN: The Assessing Care of Vulnerable Elders (ACOVE) project employed 203 QIs for care of 22 conditions (including six geriatric syndromes and 11 age-associated diseases) for community-based persons aged 65 and older at increased risk of functional decline or death. Relevant QIs were excluded for persons deciding against hospitalization or surgery. A 12-member clinical committee (CC) of geriatric experts rated whether each QI should be applied in scoring quality of care for persons with advanced dementia (AdvDem) or poor prognosis (PoorProg). Using content analysis, CC ratings were formulated into a model of QI exclusion. Quality scores with and without excluded QIs were compared. SETTING: Enrollees in two senior managed care plans, one in the northeast United States and the other in the southwest. PARTICIPANTS: CC members evaluated applicability of QIs. QIs were applied to 372 vulnerable elders in two senior managed care plans. MEASUREMENTS: Frequency and type of QIs excluded and the effect of excluding QIs on quality of care scores. RESULTS: Of the 203 QIs, a patient's preference against hospitalization or surgery excluded 10 and eight QIs, respectively. The CC voted to exclude 81.5 QIs (40%) for patients with AdvDem and 70 QIs (34%) for patients with PoorProg. Content analysis of the CC votes revealed that QIs aimed at care coordination, safety or prevention of decline, or short-term clinical improvement or prevention with nonburdensome interventions were usually voted for inclusion (90% and 98% included for AdvDem and Poor-Prog, respectively), but QIs directed at long-term benefit or requiring interventions of moderate to heavy burden were usually excluded (16% and 19% included, respectively). About half of QIs aimed at age-associated diseases were voted for exclusion, whereas fewer than one-quarter of QIs for geriatric syndromes were excluded. Thirty-nine patients (10%) in our field trial held preferences or had clinical conditions that would have excluded 68 QIs. This accounted for 5% of all QIs triggered by these 39 patients and 0.6% of QIs overall. The quality score without exclusion was 0.57 and with exclusion was 0.58 (P = .89). CONCLUSION: Caution is required in applying QIs to vulnerable elders. QIs for geriatric syndromes are more likely to be applicable to these individuals than are QIs for age-associated diseases. The objectives of care, intervention burdens, and interval before anticipated benefit affect QI applicability. At least for patients with AdvDem and PoorProg, identification of applicable or inapplicable QIs is feasible. In a community-based sample of vulnerable elders, few QIs are excluded.

Original languageEnglish (US)
Pages (from-to)902-907
Number of pages6
JournalJournal of the American Geriatrics Society
Volume51
Issue number7
DOIs
StatePublished - Jul 1 2003

Fingerprint

Quality of Health Care
Dementia
Geriatrics
Committee Membership
Patient Preference
Managed Care Programs
Hospitalization
Safety

All Science Journal Classification (ASJC) codes

  • Geriatrics and Gerontology

Cite this

Solomon, David H. ; Wenger, Neil S. ; Saliba, Debra ; Young, Roy T. ; Adelman, Alan ; Besdine, Richard K. ; Blazer, Dan G. ; Cassell, Christine K. ; Cummings, Jeffrey L. ; Katz, Paul R. ; Kitzman, Dalane W. ; Lavizzo-Mourey, Risa J. ; Mondoux, Linda C. ; Popovich, Rose ; Pories, Walter J. ; Wenger, Nanette. / Appropriateness of quality indicators for older patients with advanced dementia and poor prognosis. In: Journal of the American Geriatrics Society. 2003 ; Vol. 51, No. 7. pp. 902-907.
@article{9e6407a59b00429d8c8b1ee1941c53e4,
title = "Appropriateness of quality indicators for older patients with advanced dementia and poor prognosis",
abstract = "OBJECTIVES: To evaluate the applicability of process-of-care quality indicators (QIs) to vulnerable elders and to measure the effect of excluding indicators based on patients' preferences and for advanced dementia and poor prognosis. DESIGN: The Assessing Care of Vulnerable Elders (ACOVE) project employed 203 QIs for care of 22 conditions (including six geriatric syndromes and 11 age-associated diseases) for community-based persons aged 65 and older at increased risk of functional decline or death. Relevant QIs were excluded for persons deciding against hospitalization or surgery. A 12-member clinical committee (CC) of geriatric experts rated whether each QI should be applied in scoring quality of care for persons with advanced dementia (AdvDem) or poor prognosis (PoorProg). Using content analysis, CC ratings were formulated into a model of QI exclusion. Quality scores with and without excluded QIs were compared. SETTING: Enrollees in two senior managed care plans, one in the northeast United States and the other in the southwest. PARTICIPANTS: CC members evaluated applicability of QIs. QIs were applied to 372 vulnerable elders in two senior managed care plans. MEASUREMENTS: Frequency and type of QIs excluded and the effect of excluding QIs on quality of care scores. RESULTS: Of the 203 QIs, a patient's preference against hospitalization or surgery excluded 10 and eight QIs, respectively. The CC voted to exclude 81.5 QIs (40{\%}) for patients with AdvDem and 70 QIs (34{\%}) for patients with PoorProg. Content analysis of the CC votes revealed that QIs aimed at care coordination, safety or prevention of decline, or short-term clinical improvement or prevention with nonburdensome interventions were usually voted for inclusion (90{\%} and 98{\%} included for AdvDem and Poor-Prog, respectively), but QIs directed at long-term benefit or requiring interventions of moderate to heavy burden were usually excluded (16{\%} and 19{\%} included, respectively). About half of QIs aimed at age-associated diseases were voted for exclusion, whereas fewer than one-quarter of QIs for geriatric syndromes were excluded. Thirty-nine patients (10{\%}) in our field trial held preferences or had clinical conditions that would have excluded 68 QIs. This accounted for 5{\%} of all QIs triggered by these 39 patients and 0.6{\%} of QIs overall. The quality score without exclusion was 0.57 and with exclusion was 0.58 (P = .89). CONCLUSION: Caution is required in applying QIs to vulnerable elders. QIs for geriatric syndromes are more likely to be applicable to these individuals than are QIs for age-associated diseases. The objectives of care, intervention burdens, and interval before anticipated benefit affect QI applicability. At least for patients with AdvDem and PoorProg, identification of applicable or inapplicable QIs is feasible. In a community-based sample of vulnerable elders, few QIs are excluded.",
author = "Solomon, {David H.} and Wenger, {Neil S.} and Debra Saliba and Young, {Roy T.} and Alan Adelman and Besdine, {Richard K.} and Blazer, {Dan G.} and Cassell, {Christine K.} and Cummings, {Jeffrey L.} and Katz, {Paul R.} and Kitzman, {Dalane W.} and Lavizzo-Mourey, {Risa J.} and Mondoux, {Linda C.} and Rose Popovich and Pories, {Walter J.} and Nanette Wenger",
year = "2003",
month = "7",
day = "1",
doi = "10.1046/j.1365-2389.2003.513331.x",
language = "English (US)",
volume = "51",
pages = "902--907",
journal = "Journal of the American Geriatrics Society",
issn = "0002-8614",
publisher = "Wiley-Blackwell",
number = "7",

}

Solomon, DH, Wenger, NS, Saliba, D, Young, RT, Adelman, A, Besdine, RK, Blazer, DG, Cassell, CK, Cummings, JL, Katz, PR, Kitzman, DW, Lavizzo-Mourey, RJ, Mondoux, LC, Popovich, R, Pories, WJ & Wenger, N 2003, 'Appropriateness of quality indicators for older patients with advanced dementia and poor prognosis', Journal of the American Geriatrics Society, vol. 51, no. 7, pp. 902-907. https://doi.org/10.1046/j.1365-2389.2003.513331.x

Appropriateness of quality indicators for older patients with advanced dementia and poor prognosis. / Solomon, David H.; Wenger, Neil S.; Saliba, Debra; Young, Roy T.; Adelman, Alan; Besdine, Richard K.; Blazer, Dan G.; Cassell, Christine K.; Cummings, Jeffrey L.; Katz, Paul R.; Kitzman, Dalane W.; Lavizzo-Mourey, Risa J.; Mondoux, Linda C.; Popovich, Rose; Pories, Walter J.; Wenger, Nanette.

In: Journal of the American Geriatrics Society, Vol. 51, No. 7, 01.07.2003, p. 902-907.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Appropriateness of quality indicators for older patients with advanced dementia and poor prognosis

AU - Solomon, David H.

AU - Wenger, Neil S.

AU - Saliba, Debra

AU - Young, Roy T.

AU - Adelman, Alan

AU - Besdine, Richard K.

AU - Blazer, Dan G.

AU - Cassell, Christine K.

AU - Cummings, Jeffrey L.

AU - Katz, Paul R.

AU - Kitzman, Dalane W.

AU - Lavizzo-Mourey, Risa J.

AU - Mondoux, Linda C.

AU - Popovich, Rose

AU - Pories, Walter J.

AU - Wenger, Nanette

PY - 2003/7/1

Y1 - 2003/7/1

N2 - OBJECTIVES: To evaluate the applicability of process-of-care quality indicators (QIs) to vulnerable elders and to measure the effect of excluding indicators based on patients' preferences and for advanced dementia and poor prognosis. DESIGN: The Assessing Care of Vulnerable Elders (ACOVE) project employed 203 QIs for care of 22 conditions (including six geriatric syndromes and 11 age-associated diseases) for community-based persons aged 65 and older at increased risk of functional decline or death. Relevant QIs were excluded for persons deciding against hospitalization or surgery. A 12-member clinical committee (CC) of geriatric experts rated whether each QI should be applied in scoring quality of care for persons with advanced dementia (AdvDem) or poor prognosis (PoorProg). Using content analysis, CC ratings were formulated into a model of QI exclusion. Quality scores with and without excluded QIs were compared. SETTING: Enrollees in two senior managed care plans, one in the northeast United States and the other in the southwest. PARTICIPANTS: CC members evaluated applicability of QIs. QIs were applied to 372 vulnerable elders in two senior managed care plans. MEASUREMENTS: Frequency and type of QIs excluded and the effect of excluding QIs on quality of care scores. RESULTS: Of the 203 QIs, a patient's preference against hospitalization or surgery excluded 10 and eight QIs, respectively. The CC voted to exclude 81.5 QIs (40%) for patients with AdvDem and 70 QIs (34%) for patients with PoorProg. Content analysis of the CC votes revealed that QIs aimed at care coordination, safety or prevention of decline, or short-term clinical improvement or prevention with nonburdensome interventions were usually voted for inclusion (90% and 98% included for AdvDem and Poor-Prog, respectively), but QIs directed at long-term benefit or requiring interventions of moderate to heavy burden were usually excluded (16% and 19% included, respectively). About half of QIs aimed at age-associated diseases were voted for exclusion, whereas fewer than one-quarter of QIs for geriatric syndromes were excluded. Thirty-nine patients (10%) in our field trial held preferences or had clinical conditions that would have excluded 68 QIs. This accounted for 5% of all QIs triggered by these 39 patients and 0.6% of QIs overall. The quality score without exclusion was 0.57 and with exclusion was 0.58 (P = .89). CONCLUSION: Caution is required in applying QIs to vulnerable elders. QIs for geriatric syndromes are more likely to be applicable to these individuals than are QIs for age-associated diseases. The objectives of care, intervention burdens, and interval before anticipated benefit affect QI applicability. At least for patients with AdvDem and PoorProg, identification of applicable or inapplicable QIs is feasible. In a community-based sample of vulnerable elders, few QIs are excluded.

AB - OBJECTIVES: To evaluate the applicability of process-of-care quality indicators (QIs) to vulnerable elders and to measure the effect of excluding indicators based on patients' preferences and for advanced dementia and poor prognosis. DESIGN: The Assessing Care of Vulnerable Elders (ACOVE) project employed 203 QIs for care of 22 conditions (including six geriatric syndromes and 11 age-associated diseases) for community-based persons aged 65 and older at increased risk of functional decline or death. Relevant QIs were excluded for persons deciding against hospitalization or surgery. A 12-member clinical committee (CC) of geriatric experts rated whether each QI should be applied in scoring quality of care for persons with advanced dementia (AdvDem) or poor prognosis (PoorProg). Using content analysis, CC ratings were formulated into a model of QI exclusion. Quality scores with and without excluded QIs were compared. SETTING: Enrollees in two senior managed care plans, one in the northeast United States and the other in the southwest. PARTICIPANTS: CC members evaluated applicability of QIs. QIs were applied to 372 vulnerable elders in two senior managed care plans. MEASUREMENTS: Frequency and type of QIs excluded and the effect of excluding QIs on quality of care scores. RESULTS: Of the 203 QIs, a patient's preference against hospitalization or surgery excluded 10 and eight QIs, respectively. The CC voted to exclude 81.5 QIs (40%) for patients with AdvDem and 70 QIs (34%) for patients with PoorProg. Content analysis of the CC votes revealed that QIs aimed at care coordination, safety or prevention of decline, or short-term clinical improvement or prevention with nonburdensome interventions were usually voted for inclusion (90% and 98% included for AdvDem and Poor-Prog, respectively), but QIs directed at long-term benefit or requiring interventions of moderate to heavy burden were usually excluded (16% and 19% included, respectively). About half of QIs aimed at age-associated diseases were voted for exclusion, whereas fewer than one-quarter of QIs for geriatric syndromes were excluded. Thirty-nine patients (10%) in our field trial held preferences or had clinical conditions that would have excluded 68 QIs. This accounted for 5% of all QIs triggered by these 39 patients and 0.6% of QIs overall. The quality score without exclusion was 0.57 and with exclusion was 0.58 (P = .89). CONCLUSION: Caution is required in applying QIs to vulnerable elders. QIs for geriatric syndromes are more likely to be applicable to these individuals than are QIs for age-associated diseases. The objectives of care, intervention burdens, and interval before anticipated benefit affect QI applicability. At least for patients with AdvDem and PoorProg, identification of applicable or inapplicable QIs is feasible. In a community-based sample of vulnerable elders, few QIs are excluded.

UR - http://www.scopus.com/inward/record.url?scp=0037963484&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0037963484&partnerID=8YFLogxK

U2 - 10.1046/j.1365-2389.2003.513331.x

DO - 10.1046/j.1365-2389.2003.513331.x

M3 - Article

C2 - 12834508

AN - SCOPUS:0037963484

VL - 51

SP - 902

EP - 907

JO - Journal of the American Geriatrics Society

JF - Journal of the American Geriatrics Society

SN - 0002-8614

IS - 7

ER -